The current fee-for-service health care system places extraordinary pressures on clinical translational research, especially activities which take place in high-cost, revenue generating facilities such as surgical operating rooms and imaging suites. These facilities rely on both procedural efficiencies and space economies to maximize patient throughput. Translational research is essential to developing new clinical technologies and procedures as well as for evaluating clinical outcomes;yet, has become increasing difficult to conduct in the current health-care environment because it is highly disruptive to clinical workflow. To address this challenge, and provide critical infrastructure to support Dartmouth's areas of excellence in clinical translational research associated with imaging and image-guided interventions and surgical observational and outcomes studies, we propose to create the Advanced Surgical Center, a dedicated research facility consisting of twin operating theaters with intraoperative imaging systems that move between adjoining diagnostic suites. This new research infrastructure will (a) enhance nationally-recognized research programs in neurosurgery and orthopedic surgery, (b) leverage similarly well-funded research in neuro-imaging and breast imaging to spawn innovative new programs in interventional psycho-therapeutics and intraoperative biomarkers for surgical resection guidance, and (c) augment emerging research programs in prostate surgery, intraoperative oximetry imaging and in vivo optical microscopy. Once completed and fully functional, the ASC will offer advanced imaging, image-guidance and data collection tools, which will be used to substantiate and/or validate medical discoveries, clinical hypotheses and procedural innovations. Modalities will include intraoperative MR, CT, ultrasound, optical imaging, and other novel measurement technologies. This proposal represents an extraordinary opportunity to preserve and amplify Dartmouth's clinical translational research commitment through the ARRA stimulus funds at a time when the local, regional, and national economies are stressed, and when, as a result, institutional resources for such infrastructure projects are inadequate. Costs of $10M are being requested through this C06 proposal for the construction funds and fixed (non-scientific) equipment necessary to create the facility, accompanied by an institutional commitment to install the commercially available imaging and surgical equipment and non-fixed instruments necessary to make the ASC fully operational. The proposed initiative will create immediate economic stimulus within the State of New Hampshire and the region through the awarding of the construction contracts necessary to create the new facility. As a result of these plans, we also expect growth in our already extensive NIH grant portfolio in translational research, which will lead to new jobs that will in turn contribute to the recovery and sustainability of the NH economy.